| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $79 | $98 | $118 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $107 | $157 | $207 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $157 | $190 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $148 | $216 | $283 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $71 | $109 | $147 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $86 | $108 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $119 | $142 | $165 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $46 | $47 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $8 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $129 | $228 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $129 | $224 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $195 | $195 | $195 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $82 | $210 | $338 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $115 | $254 | $407 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $79 | $117 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $55 | $132 | $170 |
| EMG needle each extremity complete CPT 95886 • Neurology | $82 | $92 | $103 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $92 | $94 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $113 | $116 | $118 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $60 | $148 | $237 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $180 | $182 | $184 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $110 | $152 | $193 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $94 | $114 | $125 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $101 | $168 | $222 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $169 | $259 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $164 | $273 | $440 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $27 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $56 | $74 | $94 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $92 | $122 | $154 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $115 | $154 | $249 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $186 | $245 | $305 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $132 | $168 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $181 | $228 | $269 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $215 | $303 | $385 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $55 | $61 | $66 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $98 | $114 | $123 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $141 | $174 | $204 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $100 | $115 | $124 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $114 | $155 | $182 |
| Consultation office low complexity CPT 99243 • Office Visits | $130 | $161 | $186 |
| Consultation office high complexity CPT 99245 • Office Visits | $237 | $319 | $381 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $419 | $808 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $49 | $68 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,610 | $1,610 | $1,610 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $436 | $436 | $436 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $752 | $1,474 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $528 | $656 | $784 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $568 | $568 | $568 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,349 | $1,349 | $1,349 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $961 | $961 | $961 |